Articles: intubation.
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To determine the availability of end-tidal CO2 measurement in confirmation of endotracheal tube placement in the non-arrest patient, and to assess its use in academic and non-academic emergency departments. ⋯ Despite recommendations from national organisations that endorse continuous monitoring of end-tidal CO2 for confirming endotracheal tube placement, it is neither widely available nor consistently applied.
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Pediatr Crit Care Me · May 2005
Multicenter StudyExtubation failure in pediatric intensive care incidence and outcomes.
To evaluate the hypotheses that children requiring reintubation are at an increased risk of prolonged hospitalizations, congenital heart disease, and death compared with age- and disease-severity-matched control patients. ⋯ In the present trial, 4.1% of mechanically ventilated children failed extubation. Pediatric intensive care unit patients with failed extubation have longer hospital, pediatric intensive care unit, and ventilator courses but are not at increased risk of death relative to nonfailed extubation patients.
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Critical care medicine · Feb 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPrevention of acquired infections in intubated patients with the combination of two decontamination regimens.
The use of topical polymyxin and tobramycin to prevent intensive care infections is controversial. Moreover, these antibiotics are ineffective against methicillin-resistant Staphylococcus aureus. A decontamination regimen using mupirocin and chlorhexidine could prevent acquired infections, including those involving S. aureus. Because these two regimens could have a complementary role, we evaluated their effects when given both alone and combined. ⋯ Acquired infections were substantially reduced by mupirocin/chlorhexidine plus polymyxin/tobramycin, whereas each regimen given alone was ineffective. Whether both regimens could increase Candida infections deserves further investigation.
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Multicenter Study
Failed tracheal intubation in obstetrics: no more frequent but still managed badly.
In the South-West Thames region of the United Kingdom, during a 5-year period from 1999 to 2003, there were 20 failed tracheal intubations occurring in 4768 obstetric general anaesthetics (incidence 1 : 238). In half of the 16 cases for which the patient's notes could be examined there was a failure to follow an accepted protocol for failed tracheal intubation.
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A postal survey of the 38 Ambulance Services in the United Kingdom was undertaken to find out what equipment is provided for paramedic crews to aid tracheal intubation and to confirm tracheal placement. The response rate to our survey was 100%. Fourteen (37%) ambulance services provided neither stylet nor bougie to facilitate difficult intubation. ⋯ Twenty-nine (76%) ambulance services had no type of device other than a stethoscope to confirm tracheal tube placement. This survey showed wide variations in the equipment for airway management available to paramedic crews in the United Kingdom. We recommend provision of a standard set of airway management equipment to all paramedic crews in the United Kingdom together with introduction of appropriate training programmes.